Exploring the Need of HPV Education Programs in Korean American Communities

Given the significantly higher cervical cancer risks faced by Korea Americans (KA), the aim of this study was to explore cultural influences and barriers affecting human papillomavirus (HPV) vaccination decisions and preferred educational methods to effectively deliver HPV information. Focus groups included 20 KA parents. This study found a lack of knowledge about HPV and the vaccine, along with negative perceptions about the vaccine, affects HPV vaccination decision-making. Ineffective conversations and a lack of HPV vaccine recommendations by health care providers influenced by cultural beliefs were found to be another major barrier. These findings reveal new insights to guide the development of HPV education programs.     

Increasing Human Papillomavirus Vaccination Rates Among Adolescents: Overcoming Vaccine Hesitancy and Using Practice Improvements

The human papillomavirus (HPV) is responsible for thousands of cases of cancer annually, including cancers of the cervix, oropharynx, and anogenital areas. Since 2006, a vaccine for HPV has been available that offers the hope of dramatically reducing rates of HPV-related cancers. Rates of vaccination for HPV are much lower than rates of other recommended childhood vaccinations, because of difficulties reaching teenage patients and hesitancy toward the vaccine. This article provides recommendations to help pediatric and family practice providers increase rates of uptake of the HPV vaccine among adolescent patients, including communication strategies, and practice improvements that encourage vaccination.     

HPV Vaccination: Does It Have a Role in Preventing Penile Cancer and Other Preneoplastic Lesions?

ObjectivesHuman papillomavirus (HPV) is the most common sexually transmitted infection globally, which causes nearly all cervix carcinomas and contributes to oropharyngeal, penile, vulva, vagina, and anal cancers. Despite the role of HPV in several preneoplastic and cancerous lesions in men, male vaccine coverage is low. This article aims to provide insights into the pathophysiology of HPV-related penile cancer and penile intraepithelial neoplasia (PeIN). Moreover, this review endeavors to outline the advantages of implementing HPV vaccination in male vaccination programs and the role of health care providers in this mission.Data SourcesThis is a narrative review of relevant literature. A search on PubMed and Cochrane database was conducted. The following search terms were used: HPV vaccination, gender-neutral vaccination, male, genital warts, penile cancer, vaccine recommendations.ConclusionHPV is responsible for 50.8% of penile cancers globally, 79.8% of PeIN, and 90% of genital warts. In 2009 the Food and Drug Administration licensed the quadrivalent HPV vaccine for use in males, with a potential efficacy of 90% and 77.5% to reduce genital warts and anal intraepithelial neoplasia, respectively. However, the uptake of HPV vaccination in men is low, and gender-neutral vaccination is estimated to be implemented only in 42 countries worldwide. Because data in penile cancer are lacking, further research is needed to study the efficacy of incorporation of HPV vaccines in male vaccination programs on preventing penile cancer and PeIN.Implications for Nursing PracticeNurses and other members of the multidisciplinary team should take every opportunity to recommend HPV vaccination in adolescent men. Moreover, they play an important role in raising community awareness about the incidence of HPV and the related range of diseases. A practical approach is needed to incorporate HPV vaccines in vaccination programs and to optimize vaccination coverage.     

Race,Ethnicity, and Income Factors Impacting Human Papillomavirus Vaccination rates

Background

Human papillomavirus (HPV) infection and cervical cancer disproportionately affect low-income and minority women. HPV vaccines have the potential to either reduce or exacerbate racial disparities in HPV-related diseases and cervical cancers, depending on the equitability of vaccine uptake.

Objectives

This review aims to identify barriers and facilitators of equitable uptake of HPV vaccination among low-income and minority girls. This review discusses factors related to race, ethnicity, and income that are associated with initiation and completion rates of the 3-dose HPV vaccine series and presents targets for intervention.

Methods

We reviewed relevant English-language literature to identify current vaccination rates and factors associated with vaccine uptake. Study findings related to race (black, Latino, Asian), and incomes were summarized.

Results

Current trends in the United States indicate low uptake among all adolescents, and that rates stagnated between 2011 and 2012. Low-income and minority adolescents are equally or more likely to start the HPV vaccination series than are white and higher-income adolescents, but are less likely to complete all 3 shots. Provider recommendation is a key factor in HPV vaccination, and minorities are less likely to report receiving recommendations for HPV vaccination.

Conclusions

As black, Hispanic, and Asian populations continue to grow in the United States over the next several decades, it is imperative that we not only improve HPV vaccination rates overall, but also focus on high-risk populations to prevent an increase in cervical cancer disparities.     

On surmounting the barriers to HPV vaccination: we can do better

The major impediment to increased human papillomavirus (HPV) vaccination coverage in young males and females is lack of health care provider recommendation. Despite its efficacy in preventing cervical cancer, HPV vaccination in females (49.5%) and males (37.5%) ages 13 through 17 falls well below the Centers for Disease Control and Prevention’s (CDC) Healthy People 2020 target of 80% coverage. Parents’ willingness to vaccinate their child has been shown to be much higher when physicians share personal vaccination decisions for their own children as well as what other parents have done at that particular clinic. Furthermore, the vaccine must be presented presumptively as a “bundle” along with the rest of the standard adolescent vaccine panel. Multiple exemplars presented including in several European countries, low-income countries and Rwanda, demonstrate that school-based health care systems dramatically increase vaccination coverage. Finally, acceptability for vaccination of males must improve by increasing provider recommendation and by presenting the HPV vaccine as a penile, anal and oropharyngeal cancer prevention therapy in males and not merely a vaccine to prevent cervical cancers in females. Paediatricians, obstetrician/gynaecologists and primary care physicians should consider these data as a call-to-action.

• Key messages

• ??Despite recent efforts in the US, only 49.5% of females and only 37.5% of males ages 13 through 17 have received all recommended HPV vaccine doses. These numbers fall well below the 80% target set forth by the Healthy People 2020 initiative.

• ??According to the CDC, if health care providers increase HPV vaccination rates in eligible recipients to 80%, it is estimated that an additional 53,000 cases of cervical cancer could be prevented during the lifetime of those younger than 12 years. Furthermore, for every year that the vaccination rate does not increase, an additional 4400 women will develop cervical cancer.

• ??First and foremost, healthcare providers (HCPs) must make a strong recommendation to vaccinate patients and these recommendations must become routine, including for males.

• ??It is clear that HPV vaccination rates improve significantly when vaccine administration occurs at designated, well-organized sites such as school-based vaccination programmes. Furthermore, HPV vaccination should be a high school requirement and offered in the standard adolescent vaccine panel as a bundle with Tdap and MenACWY vaccines in order to promote maximum adherence.

• ??Finally, research on immunogenicity and antibody titre longevity needs to be done in newborns. The HPV vaccine may be recommended in the newborn panel of vaccines to avoid any issues of sexualization and misplaced fears of sexual disinhibition, akin to the success of the Hepatitis B vaccine in the 1980s.

• ??The HPV vaccine is a vaccine against cancer and should be aggressively marketed as such. As healthcare providers, we need to make every effort to overcome barriers, real or perceived, to protecting our population from potential morbidity and mortality associated with this virus.

     

Lessons from the failure of human papillomavirus vaccine state requirements

The licensure in 2006 of a vaccine against the subtypes of human papillomavirus (HPV) responsible for the majority of cervical cancers and genital warts was heralded as a watershed moment for vaccination, cancer prevention, and global health. A safe and effective vaccine against HPV has long been viewed as an enormous asset to cervical cancer prevention efforts worldwide. This is particularly true for places lacking robust Pap screening programs where cervical cancer has the greatest prevalence and mortality. Well before its licensure, however, some observers noted significant obstacles that would need to be addressed in order for an HPV vaccination program to succeed. These included the vaccine's relatively high cost, availability, and opposition from socially conservative groups. Such concerns associated with the implementation of HPV vaccination were soon overwhelmed by the furor that followed the unexpectedly early efforts by the US state governments to require the vaccine as a condition of attendance in public schools, proposals imprecisely referred to as "mandates." In this study, we review the controversy surrounding this debate and its effects on important ethical and public health issues that still need to be addressed.     

HPV vaccine: immersed in controversy

There has been substantial media coverage of the quadrivalent human papillomavirus (HPV) vaccine since the Food and Drug Administration approved Gardasil (Merck & Co., Inc.) on June 8, 2006. The most vocal complaints maintain that its use will promote promiscuity among teenagers, and condemn proposed mandated use for school entry. Some also question evidence for the vaccine's safety. There have been concerns raised by both providers and patients regarding financial barriers to access. Still others argue that additional populations could benefit who have not been included in current recommendations. Clarification of these issues is essential to advance optimal use of this important new vaccine. There is strong evidence to support HPV vaccine as an effective, safe, and efficient public health measure. School mandates are valuable tools to reduce disparities in availability of immunizations. The time has come to consider universal funding as a means to improve access to all recommended vaccines.     

Issues and challenges in implementing cervical cancer screenings in the emergence of HPV vaccination in Thailand

The discovery of the HPV vaccine has been a major breakthrough in preventing cervical cancer and other HPV-related diseases around the globe. Cervical cancer is a significant public health problem in Thailand. Despite the long-time availability of cervical cancer screening programs in Thailand, the uptake among the target female population remains low. HPV vaccines were approved by the Food and Drug Administration of Thailand in 2007. As of March 2011, due to financial limitations, HPV vaccines have still not been included in the national immunization program under the public health benefit plans although individuals has the option to pay privately for the vaccine. This paper discusses the issues and challenges in implementing cervical cancer screening programs in the era of HPV vaccination in Thailand. Recommendations to increase the uptake of cervical cancer screening and further research to inform a policy regarding the cervical cancer screening measures are proposed.     

Evidence-Based Practice Model to Increase Human Papillomavirus Vaccine Uptake: A Stepwise Approach

ObjectiveTo increase uptake of human papillomavirus (HPV) vaccination by implementing a stepwise evidence-based practice model to offer HPV education along with a strong provider recommendation to parents of youth and adolescents.DesignEvidence-based practice change model.SettingA nurse practitioner–run, primary care walk-in clinic in a rural area of the southeastern United States.ParticipantsParents of youth and adolescents ages 11 to 17 years.Interventions/MeasurementsEducation targeting parental hesitancy and strong recommendations for immunization was administered by health care providers to parents of youth and adolescents eligible for vaccination. The Parent Attitudes About Childhood Vaccine instrument was used to identify the presence and degree of parental hesitancy. Vaccination uptake was measured and compared to the same time period from the previous year.ResultsData collected from the clinic vaccination log during the same 6-week time period in 2018 identified that four youth/adolescents were vaccinated with the HPV vaccine in 2018. During the same 6-week period in 2019 when the practice change was implemented, 38 parents were approached; 24 met eligibility criteria, and all 24 of their youth/adolescents received HPV vaccination.ConclusionImplementation of an evidence-based practice model that includes standing vaccine orders and reminders and recalls may provide an effective way to ensure completion of the HPV vaccine series. Every missed clinical opportunity to vaccinate youth and adolescents against HPV can contribute to lower vaccination rates and increased risk for genital warts and cancers associated with HPV infection.     

An Update on Childhood and Adolescent Vaccines

In 2008, the recommendations for vaccines in children and adolescents changed substantially. The Advisory Committee on Immunization Practices expanded the routine use of influenza vaccines. New recommendations also addressed the newly licensed rotavirus vaccine. Furthermore, the Advisory Committee on Immunization Practices addressed the use of the meningococcal conjugate vaccine in children aged 2 to 10 years who are at high risk of that disease. Finally, the Food and Drug Administration and the Centers for Disease Control and Prevention reviewed the safety data collected about the human papillomavirus vaccine since its licensure and reaffirmed their recommendations for its use. This article discusses some of the important changes that should be of concern to the practitioner.ACIP = Advisory Committee on Immunization Practices; CDC = Centers for Disease Control and Prevention; FDA = Food and Drug Administration; HPV = human papillomavirus; LAIV = live attenuated influenza vaccine; MCV = meningococcal conjugate vaccine; MPSV = meningococcal polysaccharide vaccine; TIV = trivalent inactivated influenza vaccineRoutine vaccination against infectious diseases remains one of public health''s greatest accomplishments. Continued advances in science and technology have facilitated a cornucopia of advances in routine vaccination in the past 3 decades, resulting in frequent additions and revisions to the routine vaccination schedule. In 2008, the availability of vaccines as well as the licensure and recommendations for the use of vaccines in children and adolescents changed substantially. This article describes some of the more important changes that should concern the practitioner.     

CA7-03: Adolescent and Adult Immunizations: Health Impact and Cost-Effectiveness

Background/Aims The scope of vaccines recommended for adolescents and adults by ACIP has grown in number of vaccines and populations covered. We estimated the relative health impact and cost-effectiveness of these vaccines to help guide quality improvement initiative decisions. Methods Markov deterministic and micro-simulation models were used to estimate the health impact and CE ratios for birth cohorts of four million using a societal perspective. All models used methods consistent with the 'reference case' of the Panel of Cost-Effectiveness in Health and Medicine, producing results that are comparable and suitable for ranking. The influenza model recognized the 2010 ACIP recommendation for universal vaccination. The pneumococcal model recognized the recent decline in adult incidence after introduction of the PCV7 childhood vaccine. The meningococcal model included the 2010 ACIP recommendation for a booster five years after an initial vaccination at age 11 or 12. The HPV model estimated the influence of vaccine on rates of cervical cancer with and without cancer screening. Parameter estimates were from published literature. Single- and multiple-variable sensitivity analyses were performed. Results Health impacts, measured as QALYs saved during the lifetime of the cohort, were greatest for influenza vaccine (283,300), followed by HPV vaccine with screening (221,100), pneumococcal vaccine (17,100) and meningococcal vaccine (2,900). CE ratios ranged from $9,300 for adult pneumococcal vaccination to over $640,000 for adolescent meningococcal vaccination. CE of influenza vaccination for ages 18 and older was $6,100, but the vaccine was most cost-effective for ages 65 and older ($4,000) and least cost-effective for ages 18 to 49 ($260,500). HPV vaccine CE was $15,100 without screening and $17,900 with screening. Results from micro-simulation of the zoster vaccine will also be presented. Discussion Priority among preventive health care services is important because of the limited time and resources of the health care delivery system and the need to focus on the most effective services. Our consistent methods allow for comparison of estimates across a number of services. Our updated models showed the greatest health impact from HPV vaccine in the presence of screening and influenza vaccination of adults ages 65 and older.     

HPV in Men is a Women's Health Issue

Human papillomavirus (HPV) is associated with several types of cancer in both women and men, including cervical cancer, anal cancer and head and neck cancer. Public health efforts to educate consumers about HPV and vaccination have largely focused on women. This article summarizes three recent studies in which researchers examined issues regarding male attitudes and acceptance of the human papillomavirus (HPV) vaccine. All three papers suggest that vaccination of males would be beneficial to both men and women in reducing the overall HPV-related health burden. Here, the three studies are summarized and evaluated, and implications for nursing practice are discussed.     

女大学生HPV疫苗的接种意愿及影响因素分析——基于健康信念模式

目的了解浙江省女大学生自费接种人乳头状瘤病毒疫苗的意愿,以健康信念模式为框架分析女大学生自费接种人乳头状瘤病毒疫苗的影响因素,为今后开展健康教育活动及制订干预措施提供参考依据。方法采用自行设计的关于女大学生人乳头状瘤病毒的认知及人乳头状瘤病毒疫苗自费接种意愿调查问卷对302名女大学生进行调查,并采用单因素及多重线性回归分析。结果302名女大学生接种人乳头状瘤病毒疫苗行为意图得分(3.39±0.79)分,人乳头状瘤病毒疫苗的评价、知觉易感性、知觉到障碍、自我效能及行动线索是影响人乳头状瘤病毒疫苗接种行为意图的因素。结论浙江省女大学生自费接种人乳头状瘤病毒疫苗的意愿一般,受多种因素影响。     

Public Health and School Nurses’ Perceptions of Barriers to HPV Vaccination in Missouri

Human Papilloma Virus (HPV) is associated with various forms of cancer and is preventable with vaccination. Nurses are in a unique position to directly influence a person’s decision to receive the HPV vaccine. A statewide sample of both school and public health nurses was used to assess knowledge and attitudes related to the HPV vaccine as well as nurse’s behaviors and behavioral intentions toward educating parents and recommending the vaccine. Positive attitudes and adequate knowledge levels were found, however, the majority of school nurses did not provide information and resources to parents. Targeted health promotion programs for school nurses are recommended.     

北京市丰台区社区卫生服务中心医务人员流感疫苗接种现状、推荐意愿及影响因素

  目的  了解北京市丰台区社区卫生服务中心医务人员流感疫苗接种现状、推荐意愿及影响因素,为提高该人群流感疫苗接种率提供依据。  方法  采用自行设计的问卷,对北京市丰台区23家社区卫生服务中心的医务人员和公卫科负责人分别进行调查和访谈。 了解流感及流感疫苗的认知情况、2018 — 2019年度流感疫苗接种现状和推荐意愿、医务人员接种流感疫苗的相关政策等内容,采用非条件多因素logistic回归分析流感疫苗接种现状和推荐意愿的影响因素。  结果  共回收有效问卷1 359份,应答率平均为58.48%（1 359/2 324）,2018 — 2019年流感疫苗调整权重后接种率为32.81%,推荐率为79.76%（1 084/1 359）。 公共卫生等科室、知晓疫苗效果、知晓疫苗接种时间、知晓医务人员是我国推荐优先接种流感疫苗的人群、单位免费提供等因素促进流感疫苗接种。 年龄较大、医师和护士等岗位、既往接种流感疫苗、流感及流感疫苗知识得分高等因素促进流感疫苗推荐意愿。 78.26%（18/23）受访者认为流感疫苗接种率不高的原因主要是流感疫苗未免费。 91.30%（22/23）受访者建议加强流感和流感疫苗知识宣传以提高流感疫苗接种率。  结论  丰台区社区卫生服务中心医务人员流感疫苗接种率较低,推荐率较高,为医务人员免费提供疫苗并针对性开展宣传教育是提高该人群流感疫苗接种率的关键。     

Fluarix, inactivated split-virus influenza vaccine

Influenza is a potentially fatal respiratory infection resulting from several influenza virus strains. It causes annual epidemics of disease for which vaccination is the cornerstone of public health policy. The inadequacies of vaccine supply in the US during the 2004 influenza season revealed the deficiencies of current vaccine development and delivery. One outcome of this was the accelerated approval of an inactivated split-virus influenza vaccine, Fluarix. This paper reviews the immunogenicity and reactogenicity of this vaccine, and makes recommendations for the incorporation of Fluarix into the public health framework alongside other similar vaccines. Other directions to explore in an effort to secure future vaccine supply are considered.     

Design of a long-term follow-up effectiveness,immunogenicity and safety study of women who received the 9-valent human papillomavirus vaccine

The 9-valent human papillomavirus (HPV) (9vHPV) vaccine targets four HPV types (6/11/16/18) also covered by the quadrivalent HPV (qHPV) vaccine and five additional types (31/33/45/52/58). Vaccine efficacy to prevent HPV infection and disease was established in a Phase III clinical study in women 16–26 years of age. A long-term follow-up (LTFU) study has been initiated as an extension of the Phase III clinical study to assess effectiveness of the 9vHPV vaccine up to at least 14 years after the start of vaccination. It includes participants from Denmark, Norway and Sweden and uses national health registries from these countries to assess incidence of cervical pre-cancers and cancers due to the 7 oncogenic types in the vaccine (HPV 16/18/31/33/45/52/58). Incidences will be compared to the estimated incidence rate in an unvaccinated cohort of similar age and risk level. This LTFU study uses a unique design: it is an extension of a Phase III clinical study and also has elements of an epidemiological study (i.e., endpoints based on standard clinical practice; surveillance using searches from health registries); it uses a control chart method to determine whether vaccine effectiveness may be waning. Control chart methods which were developed in industrial and manufacturing settings for process and production monitoring, can be used to monitor disease incidence in real-time and promptly detect a decrease in vaccine effectiveness. Experience from this innovative study design may be applicable to other medicinal products when long-term outcomes need to be assessed, there is no control group, or outcomes are rare.     

Recommendations for Pneumococcal Immunization Outside Routine Childhood Immunization Programs in Western Europe

The global burden of pneumococcal diseases is high, with young children and adults ≥50 years of age at highest risk of infection. Two types of vaccine are available for the prevention of pneumococcal diseases caused by specific Streptococcus pneumoniae serotypes: the pneumococcal polysaccharide vaccine (PPV23) and the pneumococcal conjugate vaccine (PCV7, PCV10, and PCV13). Despite pneumococcal immunization programs in adults and children, the burden in adults has remained high. Most European countries have national or local/regional vaccination recommendations. The objective of this review was to provide an overview of the government recommendations for pneumococcal vaccination outside routine childhood vaccination programs for 16 Western European countries as of August 2014. We found that recommendations for pneumococcal immunization across Europe are complex and vary greatly among countries in terms of age groups and risk groups recommended for vaccination, as well as which vaccine should be administered. Clarifying or simplifying these recommendations and improving their dissemination could help to increase pneumococcal vaccine uptake and decrease the high burden of pneumococcal diseases in adults, both through a direct effect of the vaccine and via a herd effect in unvaccinated individuals.